Provider Demographics
NPI:1629573936
Name:BABATUNDE, AJIBOLA ABIDEMI
Entity Type:Individual
Prefix:DR
First Name:AJIBOLA
Middle Name:ABIDEMI
Last Name:BABATUNDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 NORTHWINDS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-4844
Mailing Address - Country:US
Mailing Address - Phone:678-702-4488
Mailing Address - Fax:678-285-5598
Practice Address - Street 1:2475 NORTHWINDS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-4844
Practice Address - Country:US
Practice Address - Phone:678-702-4488
Practice Address - Fax:678-285-5598
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA91068207QA0401X
NJ25MA11151100207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty